From: Interventions to improve adherence to cardiovascular disease guidelines: a systematic review
Study ID | Topic of trial | Study Design | Population description | Setting | Intervention Description; Intervention 2 description (if applicable) | Type | Duration of treatment period | Comparison intervention | Outcomes measured | Risk of bias ratinga |
---|---|---|---|---|---|---|---|---|---|---|
Ansari, 2003 | Use of beta-blockers in congestive heart failure | cRCT | Specialist doctors and nurse practitioners, patients with CHF | USA, urban medical centre | Nurse facilitator plus healthcare provider educational sessions; provider and patient reminder letters | Other type: Nurse facilitator; notifications | 1 year | Educational sessions, no nurse facilitator | Mortality, hospitalization, adherence (prescription review, chart review) | High risk of bias |
Baker, 2003 | Guidelines in prioritised review criteria | cRCT | Family doctors, patients with angina | England, general practices | Review criteria; criteria plus feedback | Other type: review criteria | 12 months | Guideline dissemination alone | Disease target (cholesterol), adherence (prescription review, chart review) | Low risk of bias |
Bertoni, 2009 | Physician adherence to ATP III guidelines | cRCT | Family doctors | USA, primary care practices | CDSS, educational sessions, academic detailing, CME sessions | Education + audit and feedback + academic detailing + CME session | 2 years | educational sessions, CME sessions, guideline mailed to participants | Disease target (cholesterol), adherence (prescription review, chart review) | High risk of bias |
Berwanger, 2012 | Multifaceted quality improvement intervention in ACS patients | cRCT | Patients with ACS at general public hospitals | Brazil, public hospitals | Training, reminders, checklists, case management, educational sessions | Education | 8 months | Routine care | Mortality, major adverse cardiac events, adherence (prescription review) | Low risk of bias |
Bonds, 2009 | Compliance to JNC 7 guidelines to improve blood pressure | cRCT | Family doctors | USA, primary care practices | Educational sessions, dissemination of guidelines, academic detailing for physicians, feedback on blood pressure control | Education + audit and feedback + academic detailing + CME sessions | 2 years | Similar to intervention but focused on ATPIII guidelines | Disease target (BP), adherence (prescription review, chart review) | Low risk of bias |
Browner, 1994 | CME and follow up to improve detection and treatment of high cholesterol | cRCT | Family and internal medicine doctors | USA, general practices | CME seminar; Intensive CME (office visits and educational materials) | Education + CME sessions | 18 months | Educational sessions | Disease target (cholesterol), adherence (chart review) | High risk of bias |
Carter, 2009 | Physician and pharmacist collaborative model to improve blood pressure | cRCT | Family doctors, patients with hypertension | USA, community based family medicine | Collaborative model, team building exercises, training sessions, educational sessions | Education + other (collaborative model) | 6 months | Collaborative model | Disease target (BP), guideline adherence tool | High risk of bias |
De Lusignan, 2013 | Audit based education to reduce blood pressure | cRCT | Mixed health care professionals | United Kingdom, primary care | Audit based education consisting of workshops; academic detailing plus workshops | Education + audit and feedback; academic detailing | 2 years | Usual care | Mortality, major adverse cardiac events, disease target (BP), adherence (prescription review) | Low risk of bias |
Deales, 2014 | Team based approach to disease and care management | cRCT | Mixed health care professionals | Italy, primary care groups | Recommendations as textbooks and decision algorithms, education sessions | Education | 12 months | Usual care | Disease target (HbA1c), adherence (chart review) | High risk of bias |
Dijkstra, 2006 | Implementation strategies for diabetes guidelines | cRCT | T1D and T2D patients | The Netherlands, hospitals | Educational meetings, feedback, reminder card; diabetes passport, education | Education + audit and feedback | 1 year | Usual care | Disease target (HbA1c), adherence (chart review) | High risk of bias |
Eaton, 2011 | Multimodal intervention to improve screening and management of hyperlipidemic patients | cRCT | Family doctors | USA, primary care practices | PDA with decision support and education toolkit and academic detailing | Academic detailing | 12 months | PDA with decision support but minimal follow up | Disease target (cholesterol), adherence (chart review) | Low risk of bias |
Eccles, 2002 | Computerised decision support system to implement angina guidelines | cRCT | Family doctors | England, general practices | Computer decision support that provided access to guidelines | Other: CDSS | 12 months | Same intervention but asthma guideline provided | Quality of life, adherence (chart review) | Low risk of bias |
Feldman, 2009 | Simplified algorithm for treatment of hypertension | cRCT | Family practices, patients with hypertension | Canada, family practices | Algorithm, aids, one follow up meeting, educational materials and sessions | Education + Other (algorithms) | 6 months | Educational sessions and guidelines | Mortality, disease target (BP), adherence (chart review) | Low risk of bias |
Fihn, 2011 | Collaborative care model based intervention to improve angina management | cRCT | Family doctors, patients with angina | USA, academic primary care clinics | Expert advice, progress evaluations, education | Education | 12 months | Usual care | Mortality, disease target, adherence (chart review) | Low risk of bias |
Fretheim, 2006 | Tailored intervention to support implementation of CVD guidelines | cRCT | Family practices, hypertensive or hypercholesterolemic patients | Norway, general practices | Tailored intervention including reminders, audit and feedback and education | Education + audit and feedback | 12 months | Passive dissemination | Disease target (cholesterol, BP), adherence (prescription review, chart review) | Low risk of bias |
Gill, 2009 | EMR-based intervention for lipid management | cRCT | Family doctors, general internists | USA, academic family practice | EMR disease management tool | Other (integration into EMR) | 12 months | Usual care | Disease target (cholesterol), adherence (chart review) | High risk of bias |
Goldstein, 2005 | Intervention on drug choice for hypertension | cRCT | Family doctors, nurse practitioners | USA, multiple sites | Education, individual drug profiles, follow up | Education | 9 months | Education on guidelines | Disease target (BP), adherence (prescription and chart review) | Low risk of bias |
Harris, 2005 | Teleconferenced educational detailing for diabetes | cRCT | Family doctors | Canada, family practices | Eight one hour small group educational sessions with opinion leaders | Education | 3 months | CME session after intervention period | Disease target (HbA1c), adherence (chart review) | High risk of bias |
Hayes, 2002 | Quality improvement and written feedback for CHF management | cRCT | Hospitals, CHF patients | USA, hospitals | Education, quality improvement tools from liaisons, chart reminders | Education + audit and feedback | 6 months | Mailed quality improvement tools | Disease target (ventricular fxn), adherence (chart review) | High risk of bias |
Headrick, 1992 | Education and feedback strategies to improve compliance with NCEP-PCEP guidelines | RCT | Resident doctors | USA. Academic hospital | Lecture, chart reminders; Lecture, patient specific feedback and chart reminder | Education + Other (reminders) | 20 weeks | Lecture alone | Disease targets (cholesterol), adherence (chart review) | Low risk of bias |
Hendriks, 2012 | Nurse led guideline based software supported ICCP | RCT | Family doctors, specialists, patients with atrial fibrillation | Netherlands, academic center | Nurse specialist educated patients and CDSS | Other (nurse specialist) | 12 months | Usual care | Mortality, hospitalizations, quality of life, adherence (chart review) | Low risk of bias |
Kiessling, 2011 | Case based training to optimize hyperlipidemia care | RCT | Family doctors, patients with CHD | Sweden, primary health care centres | Case based training seminars and guideline provided | Education | 2 years | Usual care | Mortality, disease target (cholesterol), adherence (prescription review) | High risk of bias |
Leonardis, 2012 | Multimodal intervention to improve adherence to targets | cRCT | Specialists, CKD patients | Italy, renal clinics | Education session, follow up and audits | Education + audit and feedback | 3 years | Education and standard care | Mortality, hospitalizations, quality of life, disease target (cholesterol), adherence (prescription/ chart review) | Low risk of bias |
Levine, 2011 | Multicomponent internet delivered intervention improve CHD guideline adherence | cRCT | Family doctors, MI patients | Virgin Islands and Puerto Rico, community primary care clinics | Educational cases, guidelines, monthly update, reminders | Education + Other (reminders) | 27 months | Passive dissemination | Disease target (cholesterol), adherence (chart review) | High risk of bias |
Ornstein, 2004 | Multimethod quality improvement intervention for adherence to quality indicators in CVD and stroke | cRCT | Practice based research network of practices | USA, primary care practices | Education, performance reports quarterly, practice site visits and network meetings (6–7 1–2 day visits) with pharmacist (academic detailing) | Education + academic detailing | 2 years | Education, performance reports quarterly | Disease target (BP), adherence (prescription, chart review) | High risk of bias |
Petersen, 2013 | Effect of financial incentives to reward guideline based hypertension care | cRCT | Family doctors | USA, primary care clinics | Physician level incentives; practice levels incetives; combined (both) incentives | Other (incentives) | 20 months | Usual care | Disease target (BP), adherence (prescription, chart review) | High risk of bias |
Peters-Klimm, 2009 | Educational model for GPs for the management of CHF | cRCT | Family doctors, CHF patients | Germany, general practitioner clinics | “Train the trainer” = multidisciplinary andragogic and didactic educational sessions | Education + Other (feedback) | 7 months | Single educational session by cardiologist | Mortality, hospitalizations, quality of life, disease target (course), adherence (prescription review) | Low risk of bias |
Reutens, 2012 | Education of GPs on the IDF-WPR guidelines to improve metabolic control | cRCT | Family doctors, T2D patients | Asia-Pacfic, general practitioner clinics | Education meetings (two 3 months apart), reminder letters and cards, flowsheet on patient notes, patient diabetes passport | Education + Other (reminders, diabetes passport) | 12 months | Instructed on assessments in study but no information on guidelines | Disease target (BP), adherence (chart review) | High risk of bias |
Rood, 2005 | Computer based guidelines to improve nurse measurement of patient glucose | RCT | ICU patients | The Netherlands, teaching hospital | Guideline based advice via computer decision support software | Other (decision support tool) | 10 weeks | Paper based guideline flowchart | Disease target (glucose), adherence (chart review) | High risk of bias |
Rossi, 1997 | Guideline reminders to improve prescribing based on JNC V guideline | cRCT | Nurse practitioners, hypertension patients | USA, GIM clinic | Guideline reminder for prescription and alternatives | Other (reminder) | 5 months | Usual care | Disease target (BP), adherence (prescription review) | High risk of bias |
Roumie, 2006 | Multifactorial intervention to improve quality of care of hypertension patients | cRCT | Physicians and nurse practitioners, hypertension patients | USA, community and hospital clinics | Alert on medical record; Educational sessions and alert on medical record | Education + other (alerts) | 6 months | Providers received email with guideline | Mortality, hospitalizations, disease target (BP), adherence (prescription review) | High risk of bias |
Simon, 2005 | Academic detailing individually or group to increase diuretic use in hypertension patients | cRCT | Family doctors, hypertension patients | USA, community health plan | Academic detailing meeting one-on-one; small group academic detailing session | Academic detailing | 3 months | Passive dissemination | Hospitalizations, disease target(BP), adherence (chart review) | High risk of bias |
Steyn, 2013 | Structured clinical record and training health care providers to control diabetes and hypertension | cRCT | Nurses, patients with diabetes and hypertension | South Africa, community health centres | Structured record with guideline embedded added to patient folders, educational package | Education | 1 year | Passive dissemination | Disease target (HbA1c), adherence (chart review) | High risk of bias |
Svetkey, 2009 | Intervention to increase physician adherence to BP guideline | cRCT | Physicians, hypertension patients | USA, community practice | CME courses, treatment algorithm, quarterly feedback on adherence | Education + CME session + other (feedback) | 18 months | Usual care | Disease target (BP), adherence (chart review) | Low risk of bias |
Tierney, 2003 | Decision support system with guideline for managing ischemic heart disease and CHF patients | RCT | Pharmacists, CHF patients | USA, academic primary care practice | Physicians received patient specific feedback; pharmacist system to send feedback to physicians; both | Education + audit and feedback + other (decision support system) | 1 year | Usual care | Mortality, hospitalizations, quality of life, adherence (chart review) | High risk of bias |
Van Bruggen, 2008 | Facilitator enhanced multifaceted intervention for T2D guideline implementation | cRCT | Family doctors and nurses and practice assistants, T2D patients | The Netherlands, primary care practices | Facilitators visited twice a month to train staff on guidelines, performance feedback, | Education + audit and feedback | 1 year | Usual care | Disease target (HbA1c), adherence (prescription and chart review) | Low risk of bias |
Van Steenkiste, 2007 | Decision support tool for risk management improving CVD guideline performance | cRCT | Family doctors, patients without CVD | The Netherlands, hospital | Education, decision support tool, | Other (decision support tool) | 8 months | Educational materials on guideline | Disease target (lifestyle), adherence (chart review) | High risk of bias |
Verweij, 2013 | Effectiveness of guideline based care on weight, CVD risk | cRCT | Occupational physicians | The Netherlands, occupational medicine | Environment scan, patient counselling training, patient toolkit | Other (environment scan, toolkit) | 18 months | Usual care | Quality of life, disease target (BP), adherence (chart review) | High risk of bias |